Parenting a Child With ADHD (cont.)

John Mersch, MD, FAAP

Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

What are the signs and symptoms of childhood ADHD?

The medical community
recognizes three basic expressions of the disorder:

Primarily inattentive:
The child exhibits recurrent inattentiveness and an inability to maintain focus on tasks or
activities. In the classroom, this may be the child who is "spacing out" and
"can't stay on track."

Primarily hyperactive-impulsive: Impulsive behaviors and inappropriate
movement (fidgeting, inability to keep still) or restlessness are the primary
problems. Unlike the inattentive ADHD-type child, this individual is more often
the "class clown" or "class devil" -- either manifestation leads to recurrent
disruptive problems.

Combined: This is a combination of the inattentive and
hyperactive-impulsive forms.

The combined type of ADHD is the most common. The
predominantly inattentive type is being recognized more and more, especially in
girls and in adults. The predominantly hyperactive-impulsive type, without
significant attention problems, is rare.

In the United States, ADHD affects about 3%-10% of children. Similar rates
have been reported in other developed countries such as Germany, New Zealand,
and Canada.

Usually, the abnormal behaviors are established by the time the child is about 7 years old. ADHD is rarely newly diagnosed in teenagers or young adults. Children with ADHD are often noted to be emotionally delayed, with some individuals having a delay in maturity of up to 30% when compared with their peers. Thus a 10-year-old student may behave like a 7-year-old, whereas a 20-year-old young adult may respond more like a 14-year-old teenager.

Boys are more likely than girls to be diagnosed with ADHD. At one time, the
ratio of boys to girls with ADHD was thought to be as high as 4:1 or 3:1. This
ratio has been decreasing, however, as more is known about ADHD. Greater recognition of the inattentive form of ADHD has increased the number of
girls diagnosed with the disorder.

Hyperactive symptoms may decrease with age, usually diminishing at puberty,
perhaps due to gaining greater self-control as they mature.

Inattention symptoms are less likely to fade with maturity and tend to
remain constant into adulthood.

People with ADHD are also more likely than the general population to have a
family member with ADHD.

Since 1994, the establishment of the diagnosis of childhood ADHD has relied
upon specific criteria outlined in the DSM-IV. The guidelines emphasize that symptoms must be present
for at least six months and generally were noted to be causing disruption of age-appropriate activity before 7 years of age. According to the criteria, such
disruption should occur in at least two settings (such as home and school). In
addition, these symptoms must not be better explained by another mental disorder
(such as anxiety disorder).